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Posttraumatic Stress / Trauma

Trauma is a distressing event in which a person feels severely threatened emotionally, psychologically, or physically. Most people will experience a traumatic event at some point in their lives, such as a car accident, abuse or neglect, the sudden death of a loved one, a violent criminal act, exposure to the violence of war, or a natural disaster. Many people recover from trauma with time and through the support of family and friends, bouncing back with great resiliency, but for others, the effects of trauma are lasting, causing a person to live with deep emotional pain, fear, confusion, or posttraumatic stress far after the event has passed. Often, the support, guidance, and assistance of mental health professionals is fundamental to healing from trauma.

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What Is Posttraumatic Stress (PTSD)?

Posttraumatic stress is the psychological reaction to a severely stressful and physically threatening event that often results in anxiety, flashbacks, hypervigilance, depression, suicidal ideation, and other mental health concerns for an extended period of time. People who experience PTSD may continue to feel afraid or anxious even when no danger is present.

 

A distressed woman looks out the window

PTSD is commonly associated with war veterans, and in fact, it was first classified as a mental health condition as a result of the Vietnam Veterans Working Group who lobbied the American Psychiatric Association to recognize PTSD as an official condition. The condition was finally incorporated into the Diagnostic and Statistical Manual, Third Edition (DSM-III) in 1980, and Veterans Administration Hospitals began offering treatment shortly thereafter. Prior to the 1970s, the phenomenon was casually referred to as “battle fatigue” or “shell shock.”

 

Studies indicate that 3.5% of the U.S. population will experience PTSD in any given 12-month period, and almost 37% of these cases can be classified as “severe.” Although men are statistically more likely to experience traumatic events than women, women are more than twice as likely to develop PTSD than men, perhaps due to the fact that sexual assault leads to PTSD more frequently than do other forms of trauma, and women experience sexual assault at higher rates than men do. 

Diagnosis and Symptoms

PTSD can develop from a variety of traumatic incidents, from natural disasters to sexual assault. According to the Diagnostic and Statistical Manual, 5th edition (DSM-5), to be diagnosed with PTSD, a person must have experienced or witnessed a traumatic, physically threatening event or have learned that a traumatic event happened to a close friend or family member, and display specific symptoms for at least one month. Four types of symptoms are listed in the DSM-5:

  • Avoidance Symptoms:
    • Avoiding specific locations, sights, situations, and sounds that serve as reminders of the event
    • Anxiety, depression, numbness, or guilt
  • Re-experiencing Symptoms:
  • Hyperarousal Symptoms:
  • Negative Mood and Cognition Symptoms:
    • Loss of interest in activities that were once considered enjoyable
    • Difficulty remembering details of the distressing event
    • Change in habits or behavior since the trauma

Therapy for Trauma and PTSD

Psychotherapy is the most effective form of treatment for healing from the effects of trauma. Therapy or counseling can help people who have experienced trauma and those diagnosed with PTSD make sense of their experiences and feelings, develop plans to stay safe, learn healthy coping skills, and connect with other resources and support. A qualified therapist can help people heal from trauma even long after the traumatic event took place, and unresolved trauma is one of the most common reasons people seek counseling or therapy.

 

The types of therapy that are most commonly used and recognized for their effectiveness in trauma treatment are cognitive behavioral therapy and eye movement desensitization and reprocessing (EMDR). Other forms of therapy that have been clinically tested include psychodynamic therapy, hypnotherapy, and exposure therapy. Adjunctive therapies may be used, such as group therapy or logotherapy, the goal of which is to heal through addressing the existential questions that arise in the aftermath of trauma and to discover meaning in life. In some cases, medications, such as anti-depressants, anti-anxiety medications, and mood stabilizers, are employed to help manage the more challenging symptoms of posttraumatic stress.


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According to trauma therapist Susanne Dillmann, "We may avoid situations or people that remind us of the trauma. We may be emotionally numb, depressed, or anxious. Sometimes, people turn to drugs to numb feelings of terror that last for weeks, months, and in some cases, years after a trauma. If you experience such feelings, thoughts, or behaviors after a trauma, know that such experiences are very human and nothing to be ashamed of. Through the assistance of a trained professional, one can heal from the consequences of a trauma."

Resilience and Growth

Not every case of trauma results in PTSD, in fact, most do not. Factors for resilience from trauma may include:

  • Developing a coping strategy to process and learn from the event
  • Access to social support, whether through friends and family or a designated support group
  • Feeling self-assured with regards to one’s response to the threatening situation
  • The ability to react appropriately in the face of fear

A tiny sprout emerges from black rocks and soilIn the aftermath of trauma, many people experience what psychologists Richard Tedeschi and Lawrence Calhoun have termed “posttraumatic growth”—the positive personal growth that can result from a traumatic event. The psychologists developed a posttraumatic growth inventory that measures positive outcomes across five categories:

  1. New possibilities
  2. Personal strength
  3. Relating to others
  4. Appreciation of life
  5. Spiritual change

Tedeschi and Calhoun are quick to point out that traumatic events are deeply disturbing, regardless of their potential for positive psychological change; the fact that personal growth is a possible outcome of trauma does not diminish the distressing nature of the event, nor does it lessen feelings of pain and loss.

Case Examples

  • Iraq war veteran: Ricky, 24, has recently returned from Iraq where he witnessed heavy combat. He says he was doing fine until last week when a robbery occurred in a local store while he was there. Suddenly, memories of combat flooded his senses, and he was paralyzed by them. Now he has nightmares about Iraq, but images of home get “mixed up in there.” Not only does Ricky feel overwhelmed and anxious about these flashbacks, he feels guilty for surviving while two of his friends did not, and guilty for not stopping the local robbery. Talking about his feelings helps somewhat; focusing on ways to stay safe helps as well. Ricky’s guilt is addressed by exploring the choices Ricky has made and their motivations. Ricky’s beliefs about what it means to be a man, and his high expectations of himself are also explored. The therapist helps Ricky make peace with his own mortality, and teaches Ricky relaxation skills. Ricky asks for a psychiatric referral, and he is prescribed anti-anxiety medications to help him sleep a few times a week. He is also referred to a support group. A year after his first visit, he is no longer taking medications and is feeling more hopeful, though he still struggles at times with intense grief about the war.

  • Repercussions of childhood abuse: Patricia, 39, is a highly anxious person. A full history reveals severe abuse as a child, which Patricia is reluctant to revisit. The therapist allows several sessions to go by before bringing it up again, and when she does, Patricia becomes very upset and angry. Patricia finally agrees that her reaction indicates the abuse is still “dogging” her, and she agrees to a referral for EMDR. The EMDR process helps her begin a real recovery from the abuse, and her anxiety diminishes considerably.

Resources Related to Posttraumatic Stress / Trauma:

  • Helping Traumatized Children at School - This is a clip from an educational DVD by Kathleen Nader, DSW, Making Peace With Chronic PTSD: Marla's Story. It takes a fascinating look into chronic PTSD with trauma expert, Frank Ochberg MD, once the Associate Director for the National Institute of Mental Health (NIMH), and Dr. Marla Handy, a former university lecturer with a difficult history of chronic PTSD as a result of childhood abuse and sexual trauma. This DVD is being used for counseling education, and by clinicians, social workers, educators, and trauma survivors. You can buy the full DVD from Gift From Within, a nonprofit organization for survivors of trauma and victimization. Video is copyright Gift From Within and is used by special permission for GoodTherapy.org from Gift From Within.
  • The Trauma & Mental Health Report - Written by Dr. Robert Muller, this blog is oriented toward making the difficult topic of interpersonal trauma interesting and accessible to both therapists and the general public.

Share Your Story About Posttraumatic Stress

If you are a writer or blogger who has had personal experience with posttraumatic stress, please consider sharing your story with other GoodTherapy.org readers through Share Your Story. If your story is accepted, it will be published alongside other thoughtful and inspirational mental health stories on The Good Therapy Blog.

 

References:

  1. Bradley, R., Greene, J., Russ, E., Dutra, L., & Westen, D. (2005). A multidimensional meta-analysis of psychotherapy for PTSD. The American Journal of Psychiatry, 162(2), 214-27. Retrieved from http://search.proquest.com/docview/220485782?accountid=1229
  2. Post-traumatic stress disorder among adults. (n.d.). NIMH RSS. Retrieved from http://www.nimh.nih.gov/statistics/1ad_ptsd_adult.shtml
  3. Posttraumatic Stress Disorder. (2013). American Psychiatric Association. Retrieved from http://www.dsm5.org/Documents/PTSD%20Fact%20Sheet.pdf
  4. Southwick, S. M., Gilmartin, R., McDonough, P., & Morrissey, P. (2006). Logotherapy as an adjunctive treatment for chronic combat-related PTSD: A meaning-based intervention. American Journal of Psychotherapy, 60(2), 161-74. Retrieved from http://search.proquest.com/docview/213135135?accountid=1229
  5. Tedeschi, Richard G., and Calhoun, Lawrence G. (2004). Posttraumatic Growth: Conceptual Foundations and Empirical Evidence. Psychological Inquiry, 15(1). Retrieved from http://data.psych.udel.edu/abelcher/Shared%20Documents/3%20Psychopathology%20(27)/Tedeschi,%20Calhoun,%202004.pdf
  6. Women, trauma and PTSD. (2014). National Center for PTSD. Retrieved from http://www.ptsd.va.gov/public/pages/women-trauma-and-ptsd.asp

 

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Last updated: 08-04-2014

     

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